- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $123.03 / $223.87
| Facility | 26 | $123.03 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $363.08 / $676.08
| Professional | | $245.47 | $363.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $77.62 / $102.33 / $213.80
| Professional | 26 | $77.62 | $102.33 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | 26 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $416.87 / $489.78 / $676.08
| Professional | | $416.87 | $489.78 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $134.90 / $158.49 / $223.87
| Professional | 26 | $134.90 | $158.49 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $251.19 / $371.54 / $776.25
| Professional | | $251.19 | $371.54 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $70.79 / $97.72 / $181.97
| Professional | 26 | $70.79 | $97.72 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $1,122.02 / $1,122.02 / $1,230.27
| Professional | | $1,122.02 | $1,122.02 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $489.78 / $489.78 / $660.69
| Professional | 26 | $489.78 | $489.78 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $123.03 / $218.78 / $223.87
| Facility | 26 | $123.03 | $218.78 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $562.34 / $831.76
| Professional | | $331.13 | $562.34 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $89.13 / $162.18 / $229.09
| Professional | 26 | $89.13 | $162.18 | $229.09 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $32.36 / $33.11 / $173.78
| Professional | | $32.36 | $33.11 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- 26
- Typical Low / Median / Typical High
- $346.74 / $346.74 / $346.74
| Facility | 26 | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $467.74 / $630.96 / $741.31
| Professional | | $467.74 | $630.96 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $138.04 / $173.78 / $204.17
| Professional | 26 | $138.04 | $173.78 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $245.47 / $251.19 / $870.96
| Professional | | $245.47 | $251.19 | $870.96 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $79.43 / $79.43 / $186.21
| Professional | 26 | $79.43 | $79.43 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $281.84 / $380.19 / $691.83
| Professional | | $281.84 | $380.19 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- 26
- Typical Low / Median / Typical High
- $74.13 / $91.20 / $181.97
| Professional | 26 | $74.13 | $91.20 | $181.97 |